title: Totally endoscopic atrial-septal defect repair through 3 ports.
abstract: BACKGROUND
  The standard techniques of laparoscopic surgery were first used in the late 1980s, and this method rapidly developed into a safe and effective procedure that became the standard of care. Cardiac surgery has been the last surgical specialty to completely embrace endoscopic techniques. Our working hypothesis was that atrial-septal defect (ASD) repairs can be performed by using a totally 2-dimensional endoscope view through 3 ports with results that are similar to those obtained with traditional surgical techniques.
  
  
  METHODS
  From May 2000 to May 2006, we performed totally endoscopic ASD repairs through 3 ports in 238 patients. Femorofemoral cardiopulmonary bypass and transthoracic clamp techniques were used.
  
  
  RESULTS
  The operation was performed successfully in 234 patients (98%). In 4 patients the port was enlarged to a 5-cm incision. Neither conversion to median sternotomy incision nor reoperation was necessary in any patients. Mean operation time was 2.2 +/-0.8 hours; mean cardiopulmonary bypass and aortic cross-clamp times were 66 +/- 19 minutes and 25 +/- 8 minutes, respectively. No in-hospital deaths occurred. Major postoperative complications occurred in 13 patients (5%). Echocardiographic examinations performed at the time of discharge revealed no residue leaks. Mild mitral valve regurgitation was observed in 2 patients and mild tricuspid valve regurgitation in 4 patients. Patients reported satisfaction with cosmetic results and levels of postoperative discomfort.
  
  
  CONCLUSIONS
  Totally endoscopic ASD repair through 3 ports is technically feasible and safe.
authors.affiliation: Department of Cardiovascular Surgery, No. 3 People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China. chengyunge@126.com
authors.forename: Yunge
authors.initials: Y
authors.lastname: Cheng
authors.forename: Yuejun
authors.initials: Y
authors.lastname: Wang
authors.forename: Weijun
authors.initials: W
authors.lastname: Wang
authors.forename: Jianmin
authors.initials: J
authors.lastname: Gu
authors.forename: Da
authors.initials: D
authors.lastname: Ni
mesh_terms: D000293:Adolescent; D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004724:Endoscopy / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult